CVPR Week 8: Renal diseases Part B Flashcards
1
Q
SLE AKA
A
Systemic lupus erythematosus
2
Q
SLE pathology
A
auto-immune disease
3
Q
SLE is most common in?
A
- Women
- and is 2-3 times more common in black and hispanic populations
4
Q
SLE clinical consistency
A
clinically very heterogenous
5
Q
SLE organ systems affected
A
affects multiple organ systems and is a multi-system disease
6
Q
SLE hallmark
A
- auto-antibodies
- ANA, anti-double stranded DNA, anti-Smith antibody
7
Q
SLE diagnostic criteria
A
8
Q
SLE skin findings
A
Malar Rash
9
Q
Lupus nephritis
A
- Renal disease causes significant morbidity and mortality
- Glomerulonephritis WHO classes I-VI
10
Q
Lupus nephritis pathology
A
- Caused by immune complex deposits (deposits may cause GBM duplication called “tram-tracking”
11
Q
Lupus nephritis immunofluorescence microscopy
A
staining for IgG, IgA, IgM, C3, C1q (=full house)
12
Q
Lupus nephritis full house
A
13
Q
Classifications of Lupus Nephritis
A
14
Q
Class I Lupus nephritis
A
minimal or no abnormality
15
Q
Class II Lupus nephritis
A
mesangial GN
16
Q
Class III Lupus nephritis
A
Focal proliferative GN
17
Q
Class IV Lupus nephritis
A
diffuse proliferative GN (most common)
18
Q
Class V Lupus nephritis
A
membranous lupus nephritis
19
Q
Class VI Lupus nephritis
A
chronic with glomerular scarring
20
Q
Identify
A
21
Q
Identify
A
22
Q
Identify
A
23
Q
Identify
A
24
Q
What is Amyloidosis?
A
- A group of systemic diseases defined by deposits of extracellular fibrillar proteins
25
Amyloidosis pathology
Deposits of extracellular fibrillar proteins
* deposits cause tissue damage and impair organ function
* Deposits are of abnormal misfolded proteins that normally would be degraded by macrophages
26
Amyloidosis is associated with?
neoplastic, inflammatory and inherited disorders
27
Amyloid definition
* Amyloid is a broad term encompassing \> 20 different proteins that can form abnormal fibrils
* Fibrils with beta-pleated sheet conformation
28
How are amyloid fibrils arranged
in beta-pleated sheets
29
Most common forms of systemic amyloidosis
* Amyloid light chain
* Amyloid-associated
30
AL protein AKA
Amyloid light chain
31
AA type protein AKA
Amyloid-associated
32
Identify
33
Identify
34
Identify
35
Renal amyloidosis light microscopy
* Amyloid deposited in glomerulus
* widening of mesangial matrix and GBM
* Obliterates capillary lumens
* Deposits in arteries, arterioles, peritubular (deposits are extracellular)
36
Describe amyloid deposits
amyloid deposits begin between cells, encroaches on them
Pink (or red) color on routine histology, like melted strawberry ice cream
37
Renal amyloidosis special stain
Congo red dye
38
Renal amyloidosis as seen with Congo red dye
* Orange or red color
* apple-green birefringence under polarized light
* reflects crossed beta-pleated configuration of amyloid fibrils
39
Renal amyloidosis electron microscopy features
* Thin unoriented non-branching fibrins
40
Renal involvement in diabetes
Renal failure is the 2nd most common cause of death in diabetes (after myocardial infarction)
41
The key pathogenic factor for renal damage in diabetes
* formation of advanced glycation end products
* non-enzymatic glycosylation of basement membranes
42
Renal pathology in diabetes
* **Glomerular lesions**
* capillary basement membrane thickening
* diffuse glomerulosclerosis
* Nodular glomerulosclerosis Kimmelstiel-Wilson
* Pyelonephritis
* **Renal arteriolosclerosis (hyalinosis) and atherosclerosis**
* **Pyelonephritis**
* including papillary necrosis
43
Identify
44
Identify
45
Identify
46
Identify
47
Identify
48
Identify
49
Prevalence of Acute Pyelonephritis
Very common, it is one of the most common kidney diseases
50
Acute pyelonephritis etiology
* Ascending from urethra and bladder, typically from patient's own fecal flora
* gram-negative bacilli
* E. Coli
* Proteus
* Klebsiella
* Streptococcus faecalis
51
Acute pyelonephritis risk factors
* Obstruction: stones, tumors, enlarged prostate, pregnancy
* bladder dysfunction (e.g. spinal cord injury, diabetes)
* Vesico-ureteral reflux - due to incompetent vesico-ureteral valve
leading to decreased urine flow
52
Acute pyelonephritis features of light microscopy
* Acute inflammatory cells in tubules, interstitium, kidney pelvis, bladder and urine
* white cell casts
* Edema
* Abscess formation
* Tubular necrosis in severe cases
53
Acute pyelonephritis features on urinalysis
* Neutrophils in the urine
* White cell casts in the urine
54
Identify
55
Identify
56
Identify
57
Acute pyelonephritis complications
58
Identify
59
Identify
60
Identify features and disease processes involved
In the context of Acute pyelonephritis
61
Identify features and disease processes involved
In the context of Acute pyelonephritis
62
Acute pyelonephritis can evolve?
Chronic pyelonephritis
which is the evolution into chronic inflammation with scarring
63
Describe chronic pyelonephritis
* When acute pyelonephritis evolves into chronic inflammation with scarring called chronic pyelonephritis
* Polar scars with blunted calices
* Tubular atrophy, chronic lymphocytic infiltrate and interstitial fibrosis
64
Drug-induced interstitial nephritis etiology
65
Drug-induced interstitial nephritis clinical features
* fever
* blood eosinophilia
* rash
* hematuria
* mild-proteinuria
* leukocyturia with eosinophils
* increased serum creatinine or acute renal failure
66
Drug-induced interstitial nephritis pathogenesis
abnormal immune reaction
67
Type I Drug-induced interstitial nephritis
* acute hypersensitivity (type I hypersensitivity reaction)
* The drug binds to proteins in tubular cells and becomes immunogenic (i.e. functions as hapten)
* Idiosyncratic, i.e. NOT dose-related
68
Type IV Drug-induced interstitial nephritis
* When granulomas present (less common than type I)
* Delayed-type hypersensitivity reaction (Type IV hypersensitivity reaction)
69
Identify
70
Identify
71
Drug-induced interstitial nephritis features under light microscopy
72
Drug-induced interstitial nephritis clinical course
